Acute myeloid leukemia in HIV-positive patients: biological crossroads and therapeutic Hurdles

Acute myeloid leukemia (AML), characterized by aberrant hematopoiesis and aggressive clinical behavior, remains a therapeutic challenge even with advances in targeted therapies and hematopoietic stem cell transplantation. In human immunodeficiency virus (HIV)-infected individuals, leukemogenesis may be accelerated through mechanisms such as chronic inflammation, oxidative stress, and bone marrow microenvironment dysregulation. Conversely, AML-associated immunosuppression can exacerbate HIV pathogenesis, increasing the risk of opportunistic infections and complicating disease management. The overlapping clinical presentations of AML and HIV, including cytopenias and recurrent infections, often obscure diagnosis and complicate treatment decisions. While intensive chemotherapy remains the mainstay of AML treatment, HIV-positive patients face unique challenges, including potential drug-drug interactions and compounded toxicities from concurrent antiretroviral therapy (ART) and chemotherapeutic regimens. This review aims to elucidate the bidirectional relationship between HIV and AML, focusing on relevant epidemiological data, underlying molecular mechanisms, and distinct clinical features. More importantly, it identifies critical knowledge gaps that must be addressed to optimize diagnostic and therapeutic approaches for the high-risk population.